Which part of the pharynx lies posterior to the oral cavity?
Oropharynx
Is the hard palate anterior or posterior?
Anterior to soft palate
Which structures form the hard palate?
Palatine process of the maxilla
Palatine bone
What are three muscles which make up the floor of the mouth?
Mylohyoid
Geniohyoid
Anterior belly of digastric muscle
Which bone is found inferior to the oral cavity and floats freely?
Hyoid bone
Which surface of the tongue is the underside?
Ventral surface
Which veins can be seen on the ventral surface of the tongue?
Lingual veins
Which folds are found under the tongue?
Sublingual folds
What are the three pairs of major salivary glands?
Parotid glands
Sublingual glands
Submandibular glands
Which salivary gland is found just anterior and inferior to the ear?
Parotid gland
Which duct drains the parotid gland?
Where does it emerge?
Parotid duct
Buccal mucosa
Which salivary gland is found on the floor of the mouth?
Sublingual gland
Where do the sublingual glands drain?
Sublingual folds
What is found between the sublingual folds?
What drains here?
Sublingual caruncle
Submandibular glands via the submandibular ducts, which is quite confusing
What is the structure which links the ventral surface of the tongue to the floor of the mouth?
Frenulum
Which muscle of mastication is the parotid gland superficial to?
Masseter
Which cranial nerves innervate the
a) parotid gland
b) submandibular and sublingual glands?
a) CN IX - glossopharyngeal nerve
b) CN VII - facial nerve
Which salivary glands are innervated by
a) CN VII
b) CN IX?
a) Submandibular and sublingual glands (remember that facial nerve also does the lacrimal glands)
b) Parotid glands
How does CN VII supply the submandibular and sublingual glands?
What does it hitch a ride with?
Chorda tympani
CN V3 - lingual nerve branch
Where does CN IX synapse before supplying the parotid gland?
Otic ganglion
Which kind of muscle is the tongue made up of?
Skeletal muscle
Which cranial nerves supply the general sensory fibres for:
a) anterior 2/3rds of tongue
b) posterior 1/3rd?
a) CN V3
b) CN IX
Which structure in the tongue did the thyroid gland descend through during development?
Thyroglossal duct
via the foramen caecum
What is the foramen caecum?
Hole in the tongue where the thyroid descended during development
Through which tube did the thyroid gland descend during development?
Thyroglossal duct
Which direction does the larynx move in during swallowing?
UP
then DOWN
Which direction do the thyroid gland and its remnants move during swallowing?
Why?
UP then DOWN
They’re attached to the larynx
What are the four intrinsic muscles of the tongue?
Palatoglossus
Styloglossus
Hyoglossus
Genioglossus
What is the function of the extrinsic muscles of the tongue?
Change position of tongue during
mastication
swallowing
speech
What is the motor supply to the extrinsic muscles of the tongue?
What is the exception?
CN XII - hypoglossal nerve
Palatoglossus is innervated by CN VII
Which muscles
a) modify the SHAPE of the tongue
b) modify the POSITION of the tongue?
a) Intrinsic muscles
b) Extrinsic muscles
Which cranial nerve supplies MOST of the muscles of the tongue?
CN XII
Hypoglossal nerve
Where in the brain does CN XII emerge from?
Medulla oblongata
Through which hole in the ___ cranial fossa does CN XII pass?
posterior cranial fossa
hypoglossal canal
Which bone is the hypoglossal canal found in?
Occipital bone
How do you test CN XII?
Ask patient to stick their tongue out
Which artery supplies the tongue?
Lingual artery
Which important artery does the lingual artery arise from?
EXTERNAL carotid artery
Which part of the lingual artery does CN XII pass lateral to?
Loop of the lingual artery
Which nerve passes lateral to the loop of the lingual artery?
CN XII
Hypoglossal nerve
Which tonsils are found on the lateral parts of the oral cavity, to either side of the uvula?
Palatine tonsils
What structure lies between the right and left palatine tonsils?
Uvula
What is the proper name for the gums?
Gingivae
Which border of the lips is repaired by plastic surgeons when damaged?
Vermillion border
Which bones form the majority of the hard palate?
Palatine process of the maxilla
Palatine bones
Which hole is found just posterior to the front 4 incisors?
Incisive foramen
Which plates, found at the back of the hard palate, serve as attachment for important muscles of mastication?
Medial and lateral pterygoid plates
Which bone do the medial and lateral pterygoid plates belong to?
Sphenoid bone
What are the two important muscles of the soft palate?
Right and left…
LEVATOR VELI PALATINI
TENSOR VELI PALATINI
What do the levator veli palatini muscles do?
Why is this useful?
Lift the soft palate upwards
Stops food from entering the nasopharynx
What do the tensor veli palatini muscles do?
What’s useful about this?
Tense the soft palate
Helps levator veli palatini to raise the soft palate
Which cranial nerve supplies
a) levator veli palatini
b) tensor veli palatini?
a) CN X
b) CN V3
Which muscles of the soft palate are supplied by
a) CN V3
b) CN X?
a) Tensor veli palatini
b) Levator veli palatini
Which part of the oral/nasal cavity closes off the nasopharynx to stop food from entering it?
Which part of the larynx closes off the respiratory tract to stop aspiration of stuff?
Soft palate (posterior)
Epiglottis
How do you test the muscles of the soft palate?
Which cranial nerves are you testing?
Ask patient to say AAAAH
CN V3 and CN X
What happens if nothing is wrong when you test
a) CN XII
b) CN V3 and CN X?
a) Tongue remains in midline
b) Uvula remains in midline
What happens if there’s nerve damage when you test
a) CN V3 and CN X
b) CN XII?
a) Uvula deviates AWAY from damaged side (because muscles still work on the opposite side)
b) Tongue droops ON damaged side (because muscles aren’t working)
What are the two types of muscle found in the pharynx?
Circular muscles
Longitudinal muscles
What are the three circular muscles of the pharynx?
Superior, middle and inferior constrictor muscles
What type of muscle makes up the constrictor muscles of the pharynx?
Skeletal muscle
Which cranial nerve innervates virtually all of the muscles of the pharynx?
What is the exception?
CN X
Stylopharyngeus, one of the longitudinal muscles, which is CN IX (glossopharyngeal)
Where do all of the constrictor muscles of the pharynx insert?
Midline raphe
What is another name for the upper oesophageal sphincter?
Cricopharyngeus
Apart from the circular muscles, which other muscles do the pharynx?
Longitudinal muscles
Which type of pharyngeal muscle are stylopharyngeus, palatopharyngeus and salpingopharyngeus?
Which cranial nerves innervate them?
Longitudinal muscle
Palatopharyngeus, salpingopharyngeus are both CN X like the rest
Stylopharyngeus is CN IX
What is the origin of stylopharyngeus?
Styloid process of the temporal bone
What is the origin of palatopharyngeus?
Hard palate
What is the origin of salpingopharyngeus?
Eustachian tube
just to make things confusing
What is the common insertion of stylopharyngeus, palatopharyngeus and salpingopharyngeus?
Posterior border of thyroid cartilage
Looking at the pharynx from the back, what are the openings into the nasal cavity called?
Choana
What is the ring of lymphoid tissue, found in the pharynx, called?
Waldeyer’s ring
The tonsils are all examples of ___ tissue.
lymphoid
Where do all the salivary lymphatics drain?
Which area of the neck is this structure found in?
Deep cervical lymph nodes
Carotid sheathe
Which lymph nodes should you examine in an OSCE?
Submental
Submandibular
Pre-auricular
Post-auricular
Occipital
Anterior and posterior triangles
When you palpate the pre-auricular and post-auricular areas, what are you actually feeling?
Anteriorly: parotid lymph nodes
Posteriorly: mastoid lymph nodes
When you palpate the anterior and posterior triangles of the neck, what are you feeling for?
Superficial and deep cervical nodes
What are two common causes of lymph node enlargement?
Infection
Malignancy
What are some differences between infected and cancerous lymph nodes in terms of
a) pain
b) texture
c) mobility
d) reaction to antibiotics?
a) Infected nodes are painless, cancerous nodes are painful
b) Infected nodes are soft and smooth, cancerous nodes and hard and irregular
c) Infected nodes are mobile, cancerous nodes are fixed to structures
d) Infected nodes clear up, cancerous nodes don’t
Why do you need to examine both sides in a lymph node exam?
Because lymph node drainage often crosses over and by doing one side only you may miss something